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Pediatric invasive long-term ventilation-A 10-year review
Aoibhinn Walsh1, Mairead Furlong1, Paul Mc Nally1,2
1Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.
Insights
Fewer children require invasive long-term mechanical ventilation (LTMV) over time, with improved success in weaning and decannulation. This trend impacts resource allocation for pediatric respiratory care and adult transition services.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Healthcare resource management
Background:
- The survival of children with complex pathologies, including chronic respiratory insufficiency, is increasing.
- There is a lack of data on the clinical pathway for children requiring invasive long-term mechanical ventilation (LTMV) in Ireland.
- This study examines Irish trends in pediatric LTMV to compare with global patterns.
Purpose of the Study:
- To analyze the clinical pathway and outcomes of children on invasive long-term mechanical ventilation (LTMV) in an Irish tertiary pediatric hospital.
- To identify longitudinal trends in the initiation and management of LTMV over a 10-year period.
- To assess changes in decannulation success rates for pediatric patients requiring LTMV.
Main Methods:
- A retrospective review of data from Children's Health Ireland (CHI) at Crumlin, Dublin.
- Analysis of children commenced on LTMV via tracheostomy between 2009 and 2018.
- Data divided into two epochs to evaluate longitudinal trends.
Main Results:
- Forty-six children were commenced on LTMV between 2009-2018, many with complex comorbidities.
- A significant decrease (30.4%) in new LTMV initiations was observed in the latter half of the study period.
- Children starting LTMV later in the decade showed improved treatment outcomes and shorter decannulation times.
Conclusions:
- Fewer children required LTMV annually over the 10-year period.
- Successful weaning and decannulation rates for LTMV patients have improved.
- These trends have significant implications for predicting future healthcare needs and resource allocation for pediatric and adult services.
Introduction:
The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long-term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10-year period were reviewed to see if our demographics and outcomes are in line with global trends.
Methods:
Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009-2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends.
Results:
Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year-on-year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter.
Conclusion:
Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
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